Talk Therapy Eases Hot Flashes After Breast Cancer Treatment

It was a bad dream that prompted 38-year-old Sheryl Alberico of Los Angeles to demand the mammogram that saved her life.

Although it was small, the pea-size tumor in Alberico's left breast was aggressive. Within weeks, doctors would remove both breasts and pump toxic drugs throughout her body "just in case."

Now, one day after her fourth and final round of chemotherapy, something else is haunting Alberico's sleep: Unrelenting hot flashes.

"Last night I woke up every hour," said Alberico, who is currently on disability leave from her job as an architect. "It just hits you. It feels like there's a fire inside you."

Up to 85 percent of women treated for breast cancer experience hot flashes and night sweats, the often debilitating symptoms of menopause brought on by the hormone-disrupting cancer treatments.

"I wake up my husband kicking off the covers. Neither of us gets any sleep," said Alberico, who routinely irons the cotton sheets to keep them "crisp and cold." "Sometimes I have to get up and take a shower just to cool down."

Certain drugs can provide some relief, but they don't work for everyone.

"Hormone therapy generally isn't recommended for these women because of its association with breast cancer," said Myra Hunter, a professor of clinical health psychology at King's College London's Institute of Psychiatry. "And many women want to take a non-medical approach."

Hunter and colleagues investigated whether group cognitive-behavioral therapy, a psychotherapy aimed at changing perceptions rather than physical symptoms, could help breast cancer survivors cope with hot flashes and night sweats by changing the way they think about them.

"There is some evidence that cognitive-behavioral therapy can help well women [who do not have breast cancer] cope with hot flashes and night sweats related to menopause," said Hunter. "If we can help them to counter their negative thoughts, they can learn to really let the flash flow over them."

In a study of 96 breast cancer survivors, women who received six 90-minute cognitive-behavioral therapy sessions reported significantly fewer problems with hot flashes and night sweats than women who received the usual care. The findings were published Tuesday in the Lancet Oncology.

"They're still having hot flashes, but they don't notice them as much," said Hunter.

Using relaxation techniques such as "paced breathing," the women learned to counteract the stress, embarrassment of hot flashes and their effects on mood and sleep.

Holly Prigerson, director of psychosocial oncology at the Dana-Farber Cancer Institute, said the study "demonstrates the power of the mind as medicine."

"By encouraging someone to think about physical symptoms in a different way -- a way that's less stigmatizing and more normalizing -- you can substantially improve her quality of life," said Prigerson, who wrote an editorial accompanying the study. "Just like anxiolytics or antidepressants, how you think about something can have a dramatic influence on how you feel physically and mentally."

An online version of the therapy sessions could improve access for women limited by money, geography and busy schedules, Prigerson said. But there are advantages to sharing the experience with a group of women in the same boat.

"This study didn't really parse out the effect of sharing with a group of other breast cancer survivors -- how the social support of sisters in suffering might also prove empowering and make women more resilient," Prigerson said.

Learning to counter negative emotions can give women back some of the control they feel they lost during their cancer diagnosis and treatment, Hunter said.

"I think it's very empowering, actually, because they've been going through a process where they feel as if their bodies are being managed by other people," she said. "The cognitive-behavioral therapy approach lets them feel as though they've got some control, and think they can apply that to different areas of their life."

After a double mastectomy and aggressive chemotherapy, Alberico said she likes the sound of cognitive-behavioral therapy.

"I'm just sick of all the pills and needles," she said. "If I can do something more natural, that's better. I'm in my 30s, and this is going to go on for a while, so it can't hurt to try."

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Psychotherapy May Ease Hot Flashes After Breast Cancer

TUESDAY, Feb. 14 (HealthDay News) -- After breast cancer treatment, many women suffer from hot flashes and night sweats, but a type of "talk therapy" might relieve these symptoms for some women, British researchers suggest.

In a new study, women who received this form of psychotherapy, known as cognitive behavioral therapy, had reduced their symptoms by half within six months.

"Hot flashes and night sweats are distressing symptoms, which cause social embarrassment and sleep problems, and they are challenging to treat, especially for women who have had breast cancer" because hormone replacement therapy is generally not recommended for these women, explained lead researcher Myra Hunter.

According to background information in the study, which is published in the Feb. 15 online edition of The Lancet Oncology, 65 percent to 85 percent of women have hot flashes after breast cancer treatment.

Group cognitive behavioral therapy is a safe and effective treatment for women who have hot flashes and night sweats following breast cancer treatment, Hunter said, with additional benefits to mood, sleep and quality of life.

"The women in this trial reported frequent and problematic symptoms and relatively low quality of life," said Hunter, a professor of clinical health psychology at King's College London's Institute of Psychiatry.

Hunter's team randomly assigned 96 women who had been treated for breast cancer and suffered from night sweats and hot flashes to either "talk therapy" or usual care.

The 47 women who received the therapy attended weekly 90-minute sessions for six weeks. For the others, usual care consisted of access to nurses and oncologists, telephone support and cancer support services, the researchers noted.

The therapy sessions included psycho-education, paced breathing, and behavioral strategies to manage hot flashes and night sweats, as well as interactive PowerPoint presentations, group discussion, handouts and weekly homework, Hunter said.

In addition, participants learned how to handle the stress associated with hot flashes and night sweats, and found new ways to decrease anxiety, she explained.

The women were also taught to manage hot flashes in social situations and to understand night sweats and improve sleep habits using mental and behavioral strategies.

The investigators found that the women who had received the cognitive behavioral therapy significantly reduced the number of hot flashes and night sweats they experienced in the nine weeks after the start of the study.

This reduction in symptoms lasted for 26 weeks. At nine weeks there was a 46 percent reduction in symptoms and a 52 percent reduction at 26 weeks, Hunter's team found.

However, among women receiving usual care, hot flashes and night sweats decreased by 19 percent after nine weeks and 25 percent after 26 weeks.

"These reductions were sustained and associated with significant improvements in mood, sleep and quality of life," Hunter said. "This is a safe, acceptable and effective treatment option, which can be incorporated into breast cancer survivorship programs and delivered by trained breast cancer nurses."

Holly Prigerson, director of the Center for Psycho-Oncology and Palliative Care Research at the Dana-Farber Cancer Institute in Boston, wrote an accompanying journal editorial.

"Hot flashes and night sweats are very common, distressing and persistent -- women reported being troubled by them for an average of two years after breast cancer treatment," Prigerson said.

She noted that the new study provides sound evidence upon which to recommend cognitive behavioral therapy for breast cancer patients suffering from these symptoms.

"Adaptations to an online, self-management version of the intervention would allow for more flexible scheduling and greater access at potentially lower cost of delivery," Prigerson said. "Combining the intervention with medications that effectively treat hot flashes and night sweats might produce the most dramatic effects with reductions in symptoms as well as the distress caused by them."

Prigerson said this type of therapy might also be used to treat postmenopausal women suffering from these symptoms.

"Of course, scientifically, we can't generalize beyond the sample of women who experience menopausal symptoms as a result of treatment for breast cancer," she said. "But given that they found that [this type of therapy] worked on the distress associated with hot flashes and night sweats, then it would seem likely to generalize to menopausal symptoms experienced outside of this context."

More information

For more about psychotherapy, visit the U.S. National Institute of Mental Health.

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